It is hypothesized that it is possible to use virtual reality such that it simultaneously: 1) provides non-medication analgesia for women with chronic shoulder pain following breast surgery; 2) improves their upper extremity strength/range of movement; and 3) improves their emotive state and quality of life. This implements a healthy mind in a healthy body single-point-of-care approach. The long-term objective of the project is to develop a combined therapy that is superior to separately doing physical and cognitive/behavioral therapies as non-medication palliative pain care interventions. The purpose of the present investigation is to develop and feasibility test the prototype BrightArm II system integrated with dual-arm, adaptable virtual reality games, such that the patient receives gravity-gradated assistance/resistance for gentle shoulder training. This system should accommodate low-functioning patients with chronic pain and weakness in their shoulder following breast surgery, patients for whom off-the-shelf active video games are not practical. SPECIFIC AIMS The first aim is to develop the BrightArm II system for improving arm/shoulder motion range, shoulder strength, endurance, grasp strength, memory, focusing, executive function and psycho-social correlates to shoulder pain due to cancer. The second aim is to evaluate the feasibility and acceptance of the prototype for women with chronic pain due to mastectomy, through an 8-week combined physical, cognitive and emotive therapy while simultaneously monitoring pain medication intake and activities of daily living. METHODS 1) Construct the BrightArm II system by creating a vision-tracked rehabilitation table that tilts to allow assistance/resistance to either arm and can track both arms simultaneously; 2) Develop rehabilitation game software for virtual analgesia with simulations training of the physical, cognitive and emotive aspects of chronic shoulder pain. These games will automatically adapt to arm range, grip strength and patient level of distress; 3) Develop a secure web-accessible database module for game data storage and analysis. Data will be sampled transparently in real time during play and uploaded to Bright Cloud International Corp blade server; 4) Usability study with 4 adult women without disability to uncover technical problems; 5) Feasibility study with 6 adult women with chronic shoulder pain following breast surgery to remove cancer, participating in a 8-week training program on the BrightArm II system. Subjects will be evaluated for physical and cognitive/emotive function using standardized tests pre-, mid- and post-training. Additional measures will be medication intake, and patients subjective reports of pain level, system usefulness, and independence in daily activities. This project will develop a new device and therapeutic method for virtual analgesia, arm rehabilitation and cognition/emotive therapy in an integrated way providing a single-point-of-care solution. The same approach can be extended to other patient populations with chronic shoulder pain, and to pediatric care. PUBLIC HEALTH RELEVANCE: A product that simultaneously reduces women's chronic shoulder pain, improves their arm strength and reach, and combats depression following mastectomy improves their quality of life/participation, and reduces health care costs. By integrating dual-arm physical rehabilitation for shoulder/arm/grasp reach and strength with motivating custom video games, the product improves access to health care by facilitating a single-point team-care therapy. The ability of the product to also be used in the future in acute post-surgery rehabilitation further reduces health care costs by accelerating return to productive life.